PUBLISHED
THU, DEC 17 20209:34 AM EST Sarah O’Brien@SARAHTGOBRIEN
KEY POINTS
·
Roughly 25 million
Medicare beneficiaries are enrolled in Advantage Plans.
·
From Jan. 1 to March
31, you can either swap your plan for another or drop it altogether if you
discover the one you picked during fall open enrollment doesn’t suit you.
·
Common reasons for
switching include discovering your doctor isn’t in network or the medicine you
take is not covered.
Yes,
Medicare’s annual enrollment period ended Dec. 7.
No,
not all hope is lost if you realize the Advantage Plan you picked for 2021 is a
mismatch.
That’s
because Medicare has a three-month window at the beginning of each year, Jan. 1
through March 31, when you can swap your Advantage Plan for another or drop it
and return to basic Medicare (Part A hospital coverage and Part B outpatient
coverage).
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“The
most common reason people change is that they joined a plan during the [fall
enrollment window] without realizing that one of their doctors is not in the
network or one of their medications is not covered on the formulary,” said
Danielle Roberts, co-founder of insurance firm Boomer Benefits.
Also
from Jan. 1 through March 31: If you missed your initial Medicare enrollment
period and don’t qualify for an exception,
you can sign up during that time. If this is your situation, coverage won’t
start until July 1, said Elizabeth Gavino, founder of Lewin & Gavino and an
independent broker and general agent for Medicare plans.
Of
Medicare’s 63 million or so beneficiaries, about 25 million are enrolled in an
Advantage Plan, which delivers Parts A and B and usually Part D prescription
drug coverage, along with extras such as dental and vision.
The
upcoming three-month opportunity to change or drop your Advantage Plan will
arrive just weeks after the close of Medicare’s annual fall enrollment, when a
variety of options were available for those who wanted to modify their
coverage.
In
contrast, the upcoming Advantage Plan-related window comes with restrictions.
For
starters, you can only make one switch. This means that once you move to a
different Advantage Plan or drop it for basic Medicare, the change is generally
locked in for 2021 (unless you meet an exclusion that qualifies you for a
special enrollment period).
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Additionally,
this three-month window does not allow you to switch from one stand-alone Part
D prescription drug plan to another.
If
you picked a Part D plan in the fall open enrollment period based on faulty or
misleading information, you can call 1-800-Medicare at any point during
the year to see if your situation would allow you to make a
change.
Meanwhile,
dropping an Advantage Plan in favor of basic Medicare often means losing drug
coverage — which means you would have to enroll in a stand-alone Part D plan.
This matters, because if you go 63 days without the coverage, you could face a
lifelong late-enrollment penalty that gets tacked on to your monthly premiums.
Also,
if you switch back to original Medicare and want to get a supplemental policy (aka “Medigap”),
be aware that you may not qualify for guaranteed coverage.
These policies either fully or partially cover cost-sharing of some aspects of
parts A and B, including deductibles, copays and coinsurance. However, they
come their own rules for enrolling.
If someone plans to … go back to original
Medicare and get a Medigap plan, they should be aware that they will likely
have to answer health questions. Danielle Roberts CO-FOUNDER
OF BOOMER BENEFITS
“If
someone plans to … go back to original Medicare and get a Medigap plan, they
should be aware that they will likely have to answer health questions and go
through underwriting,” Roberts said.
She
advises starting the process by applying for the Medigap plan and getting
approval before leaving the Advantage Plan or enrolling in a standalone Part D
plan.
“Enrolling
in the Part D plan will boot them out of the Medicare Advantage plan, so it’s
important to wait on that part as well,” Roberts said. “We encourage people who
need to make a change to do it early in the election period.”
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